Provider Demographics
NPI:1972367589
Name:WELLPATRIOT VETERANS MEDICAL SERVICES
Entity type:Organization
Organization Name:WELLPATRIOT VETERANS MEDICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIEF MEDICAL OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:WASHINGTON
Authorized Official - Suffix:SR
Authorized Official - Credentials:MD
Authorized Official - Phone:770-378-0942
Mailing Address - Street 1:5112 CRESCENT COVE LN
Mailing Address - Street 2:
Mailing Address - City:MABLETON
Mailing Address - State:GA
Mailing Address - Zip Code:30126-7622
Mailing Address - Country:US
Mailing Address - Phone:770-378-0942
Mailing Address - Fax:
Practice Address - Street 1:690 MIAMI CIR NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30324-3015
Practice Address - Country:US
Practice Address - Phone:404-936-6216
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-13
Last Update Date:2024-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Multi-Specialty